SEPSIS 48 HOUR MANAGEMENT PLAN
Time
Criteria
Action
Communication
Attending Medical Officer (AMO) informed that patient is on sepsis
pathway
Clinical handover must inform the receiving team that the patient was
treated for sepsis


Monitor and reassess for sepsis deterioration which may include one or
more of the following:
0 – 2 Hours
Monitor and
reassess
Respiratory rate in the Red or Yellow Zone
Systolic blood pressure < 100mmHg
Decreased or no improvement in level of consciousness
Urine output less than 0.5mL/kg/hr
No improvement in serum lactate level
If deteriorating, activate local CERS and inform AMO

If improving, continue observations every 30 minutes for 2 hours, then
hourly for 4 hours

Head to toe assessment for infection source and initiate investigations
which may include:

Diagnostic imaging

Urine MSU (or CSU) for MCS

Sputum for MCS

Faeces for C.difficile and MCS (if diarrhoea)

Wound swab for MCS

Nasopharyngeal swabs

Lumbar puncture (if indicated)
Sepsis screen
Medical officer to consult with AMO on appropriate antibiotic prescribing

Prescribe antibiotics in the medication chart and indicate the appropriate
time for dosing

Prescribe IV fluids as appropriate
Monitor haemodynamic observations

Antibiotics
IV Fluids







Time
Criteria
Action
Monitor and reassess for sepsis deterioration which may include one or
more of the following:
2 – 24 Hours
Continue
monitoring
Repeat lactate
Respiratory rate in the Red or Yellow Zone
Systolic blood pressure < 100mmHg
Decreased or no improvement in level of consciousness
Urine output less than 0.5mL/kg/hr
No improvement in serum lactate level
If deteriorating, activate local CERS and inform AMO

If improving, continue observations every 30 minutes for 2 hours, then
hourly for 4 hours

Lactate level 4 hours post recognition

Date -- /--/ ---- Time --:--
. mmol/L
Lactate level 8 hours post recognition
Date -- /--/ ---- Time --:-Fluid
Resuscitation
. mmol/ L
Prescribe IV fluids as appropriate
Monitor haemodynamic observations

Check preliminary blood counts

If patient is neutropenic, review antibiotics and change if needed

Review need for advanced care directives and ceiling of care if
appropriate

Are any other causes of deterioration likely?

Reassess
Review
treatment



Discuss with AMO and treat accordingly
Cease antibiotics if appropriate
Continue monitoring for deterioration including urine output
24 – 48
Hours
Repeat biochemistry as indicated
Review results of tests and investigations
Reassess






Discuss with AMO and treat accordingly
Cease antibiotics if appropriate
Continue monitoring for deterioration including urine output
Confirm diagnosis and document source of sepsis in medical record
This document is intended for patients who have been recognised as having sepsis and have started on a sepsis
pathway. The Sepsis 48 Hour Management Plan aims to guide clinical staff using a step by step process which
ensures that the patient monitoring and treatment is appropriate.
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